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"***NOTE: Rules for CPAP doctor's prescriptions vary from country to country. And within Canada, the province of Ontario has very specific rules which doctors MUST follow which dictates whether or not they 'qualify' for an Auto CPAP machine."

Just a small clarification on your signature comment above. There are two issues here. One is what the physician writes on the prescription(s). The second is how the physician completes the ADP (Assisted Devices Program) form.

In my case I was given two prescriptions. One for a CPAP and a second prescription for an APAP. Since a recent sleep test stated that I would not qualify for an APAP, the physician noted that on the form. Therefore, I got my prescription for an APAP, but an ADP form that would only support a CPAP purchase.

On a completely unrelated Apnea issue, I see you are a snowbird. I trust you are fully aware of the new Cross Border Initiative and realize that both the US and Canada now know exactly how many days you spend in each country, are within your 182 day limit and will file a timely form 8044.

(11-18-2015, 10:38 PM)Riven Wrote: If you fail to qualify for Ontario ADP funding for an APAP device, yes its going to be a lot more expensive! Even if you have private insurance, they may not pay if ADP won't. Also, once a vendor in Ontario knows you are not going through the ADP program, they are no longer forced to sell at the ADP controlled price and won't hesitate to tack on another $500. Also, you will still need a prescription for an APAP from you physician even though they know you failed to meet the ADP requirements.

There are plenty of DME's in Ontario, including some of the chains that are willing to sell the machines at the same price as the ADP dictates even if you were to pay for it yourself.

(11-19-2015, 08:50 AM)Riven Wrote: @ cate1898
.....
On a completely unrelated Apnea issue, I see you are a snowbird. I trust you are fully aware of the new Cross Border Initiative and realize that both the US and Canada now know exactly how many days you spend in each country, are within your 182 day limit and will file a timely form 8044.

Yes we are careful about how many days we are in the US and keep track of it. But what is Form 8044?

APNEABOARD - A great place to be if you're a hosehead!!

-------------------------------------------------------------------------------------------------EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!

(11-19-2015, 04:48 PM)ramblingasian Wrote: There are plenty of DME's in Ontario, including some of the chains that are willing to sell the machines at the same price as the ADP dictates even if you were to pay for it yourself.

I agree, but I had to contact three DME's before I found one that would sell at the ADP price. The first two were well known and they were between $400 and $600 more for an APAP unit.

Newbie here, looking to get a CPAP or APAP machine in the very near future and learning a lot from this board!

I'm unclear on what the actual issue is (from the doc's perspective, as well as ADP's perspective) with getting an APAP machine which can run as a CPAP. From checking out a few GTA vendors' websites, it looks like the difference between say a ResMed A10 Auto (APAP) vs an Elite (CPAP) is less than $100. In some cases less than $40!

So is cost really the main issue, or is there something else?

Or is it just that the ADP regulations were written at a time when the cost difference between CPAP and APAP was substantially more, and the government (rightfully, at that time) didn't want to shell out a ton more for a higher-end product that wasn't needed?

(01-29-2016, 06:57 PM)nuggie Wrote: Newbie here, looking to get a CPAP or APAP machine in the very near future and learning a lot from this board!

I'm unclear on what the actual issue is (from the doc's perspective, as well as ADP's perspective) with getting an APAP machine which can run as a CPAP. From checking out a few GTA vendors' websites, it looks like the difference between say a ResMed A10 Auto (APAP) vs an Elite (CPAP) is less than $100. In some cases less than $40!

So is cost really the main issue, or is there something else?

Or is it just that the ADP regulations were written at a time when the cost difference between CPAP and APAP was substantially more, and the government (rightfully, at that time) didn't want to shell out a ton more for a higher-end product that wasn't needed?

Thanks!

It's cost. Nothing more and nothing less. The cost on screen may be X amount, but everyone knows that a CPAP machine costs significantly less than an APAP. Vendors like that as well, as they get more profit with a CPAP machine than with an APAP, as they pay more for an APAP from the suppliers.

As an example, my VPAP was I believe only $50 more than an CPAP out of pocket. However, that VPAP costs way more than the cost difference between both machines.

I've said it before on this forum and on others - although I was eventually given a VPAP due to my diagnosis, if enough people push for ADP to provide APAP machines, they could change the rules. I'm not sure the vendors will like it though.

(01-29-2016, 07:06 PM)ramblingasian Wrote: I've said it before on this forum and on others - although I was eventually given a VPAP due to my diagnosis, if enough people push for ADP to provide APAP machines, they could change the rules. I'm not sure the vendors will like it though.

Great idea, but exactly how do you propose one would do this?

APNEABOARD - A great place to be if you're a hosehead!!

-------------------------------------------------------------------------------------------------EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!

The only way to push ADP may be increasing the numbers of APAPs vs CPAPs prescribed.
In majority cases, a CPAP with high enough pressure that brings AHI down to acceptable level is prescribed and ADP covers 75% and doesn't have to pay anything for the next 5 years.
APAPs are prescribed mostly as a result of an additional, APAP oriented sleep study ordered by the doctor. These studies are ordered (I think) in most cases at patient request. If doctors were more eager to order an APAP oriented study, there would be a lot of cases where ADP would be funding an APAP machine before 5 years is up which would mean the cost to them would go up. Possibly than, somebody at ADP would see the light and figure that it may be cost efficient to relax the rules regarding APAP qualification or, at the minimum, they would would fund the CPAP portion of the machine and allow users to pay for the difference and get an APAP.

Everything I post on this board is nothing more than an opinion expressed by an apneak. Normally, it's based on facts and experience but sometimes, I may get things wrong or not have all the facts.
I reserve the right to change my mind. Why? Because tomorrow I may know better.

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